Patient:
English Cocker Spaniel, Male, Neutered, 5 years. Gentle
dog. No Cocker Rage.
Complaint: Head shaking for several weeks. Dark
red ear wax in horizontal canal. Groomer could not
resolve this problem.
Solution: I advised surgery to open up the
vertical ear canal so that the trapped water and debris
inside the canals can flow out easily in the long term.
The couple in their 40s knew what I was talking about
and agreed to the surgery.
ANAESTHESIA
Jun 21, 2010. Anaesthesia and Surgery took over one
hour.
Pre-anaesthetic dose
Domitor 0.25 ml IV. Waited 5 minutes.
Isoflurane gas.
Intubate. "How about Zoletil IV?" my assistant Mr Saw
asked as in the recent debarking case, I had used both.
"It is best not to give more sedation drugs than
necessary. I will be using isoflurane which is safest,"
I advised him. "Less sedation drugs, less likely to get
anaesthetic deaths. If I use Zoletil, I will need to use
Atropine to prevent salivation and muscle tremors. Then
I need to top up as this surgery is going to be longer
than debarking as I have two ear surgeries to do. That
means I still need isoflurane gas to maintain surgical
anaesthesia."
Pre-anaesthetic sedation using one drug and isoflurane
gas is the safest method of anaesthesia for dogs and I
use this method frequently. In debarking, I had no
choice but to use injectable anaesthetics and there was
the hassle of topping up via the IV catheter. For gas
anaesthesia, just increase the dosage and that is so
convenient when the dog is intubated and given gas. For
injectable anaesthetic top up, it is given by small
doses via the saline drip. It is quite convenient too
but nothing is as safe as the isoflurane gas.
"Any surgery consent forms to sign?" the owner had asked
me earlier. "The owner can sign forms for the vet. The
important thing is that the dog does not die on the
operating table." Usually I assess the dog's health and
the owner's personality and I seldom give them forms to
sign. But I have always communicated to them the risks
of anaesthetic deaths. Consent forms are common even in
human anaesthesia and surgery at the Singapore
hospitals.
Performance (a live dog at the end of surgery) counts a
lot. I cannot be complacent as one anaesthetic death
creates massive waves of emotional upheavals in the
owners and the family. This English Cocker Spaniel is
healthy but still no vet can guarantee the owner that
the dog will not die on the operating table.
SURGICAL PROCEDURE
1. Clipped skin of ear to the base, not just partly. My
assistant had to shave more, increasing the anaesthetic
time. Put artery forceps to base of vertical canal to
identify the location.
2. Draw the outline of the surgical area from base of
vertical canal and add 50% more length (see picture).
3. Electro-incision of rectangular outline.
4. Excise subcutaneous fat to see the vertical canal.
5. Be careful of a big vein posterior to the
vertical canal. If cut, ligate this vein. Elevate cut
skin upwards to see the subcutaneous fat. Also be
careful not to excise the branch of a facial nerve
and salivary glands on the ventral aspect of the
incised area. If the facial nerve is excised, the
eye-lids will droop. However, the vet can't see this
nerve easily. Know your veterinary anatomy.
6. Angle forceps at 30 degrees downwards and outwards so
that the drainage board is wide and clamp anterior and
posterior edges of vertical canal.
7. Electro-incision on clamped groove.
8. Scissors to cut.
9. Lower the cartilage. Cut cartilage long enough to
anchor it to base of skin. I stitched at the horizontal
canal level first. 2/0 absorbable sutures were used.
10. To illustrate the surgical procedures, some pictures
are presented below. More pictures of the surgical
procedures in other dogs are at:
asiahomes.com/singaporetpvet/dogs/0750Schnauzer_lateral_ear_resection_Singapore.htm
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Before lateral ear resection
surgery |
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Lateral ear resection
surgery being performed by
Dr Sing |
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4 days after lateral ear resection
surgery. Goes home |
POST-OPERATION
CARE
Tolfedine painkiller injection after surgery and
orally for the next 4 days were quite effective in
controlling the pain. Dosage was 4mg/kg whether by
injection or oral. An e-collar was given.
I asked the owners to take the dog home on Day 4 to
reduce costs for them. Ideally I would like to keep the
dog for 10 days to ensure complete healing but there is
always the increase in veterinary costs for the owner
and this may not be in their interest.
"The left ear has a stitch breakdown on the lower right
side," I said to the couple. It will close. Do not wipe
the wound. The stitches will dissolve usually. I need to
review in 14 days from today."
 UPDATE
AS AT JUN 30, 2010
Some 10 days have passed. No complaints from the dog
owner.
More case studies, goto:
Ear Problems in Singapore dogs
or:
Cats or
Dogs |
TOA
PAYOH VETS
